Life is a fatal disease

Believe it or not, even your ever-lovin’ box of colored blinking lights can malfunction, and it happened to me over the weekend. Actually, sometime around New Years, I caught some sort of crud, and have been battling it since. There’s nothing like hacking up a lung and not being able to sleep well for days to put one in a perfect mood to be particularly Insolent. And so it would have been, until my part of the country managed to be buried in snow all day and night Sunday, necessitating multiple rounds of going out to use the snow blower in spite of my condition and having to get up super early to do it again so that I could get to work. As a result, I’m beat.

That doesn’t stop me from taking interest in an article published in the New York Times over the weekend entitled Why Everyone Seems to Have Cancer. Basically, it’s a neat take on the annual government Report to the Nation on the Status of Cancer, which was released shortly before the holidays last year. George Johnson, the article’s author, notes that, every year, after the report is issued, there almost inevitably arises a cry that we’re “losing the war on cancer.” That claim is a topic I’ve written about on quite a few occasions, most notoriously when I took an overly nihilistic view on cancer progress that somehow found its way into Skeptical Inquirer and irritated the crap out of me, recently having pointed out that cancer is complex and curing various cancers will be hard. Johnson then points out something I’ve pointed out before:

Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death.

Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing — and sometimes curing — cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game.

As I like to say, life is a sexually transmitted fatal disease. Nobody gets out of here alive. Success against one major killer disease (like heart disease) just means that all those people who would have died of heart disease must die of something else eventually. Of course, we’d all prefer that “something else” to be old age, whatever death from old age is, but it doesn’t have to be. So, as fewer people die of heart disease and other vascular diseases (like stroke), truly a triumph of science-based medicine, more must die of other diseases of old age, the most prominent of which is cancer. Even so, mortality from cancer has been decreasing steadily. Looking at the graph Johnson cites, you’ll notice that deaths from Alzheimer’s disease have skyrocketed since 1980, and deaths from Parkinson’s disease have also increased, although not nearly by as much.

In a way, Johnson argues, this “standoff,” as he calls it, is evidence of our success. Since 1990, heart disease mortality has declined by 44%, while cancer mortality has declined only by 20%, a fact that—I can’t resist pointing out—is contrary to the claims of all the cancer quacks that more people than ever are dying of cancer. Yes, maybe in sheer numbers that is true, but as a percentage of the population every year (i.e., deaths per 100,000 population) it is not. In any case, cancer is a disease of old age, and more and more of us are living long enough to be at risk for it. In many ways, though, as I’ve described before, heart disease is simpler. The cells that proliferate in blood vessels to cause blockages are genetically normal cells. The processes by which they proliferate, although complex, are nonetheless much simpler than the processes that result in the dozens, even hundreds, of different kinds of cancers, and the cells in these cancers are most definitely not genetically normal. They are about as far from it as possible as cells can get from “genetically normal.” Moreover, the consequences of vascular disease that result in the most common form of heart disease, which is due to decreased blood flow to the heart, can often be corrected, at least temporarily, by mechanical interventions, such as angioplasty or coronary artery bypass. Other forms of heart disease can also often be corrected with devices, such as artificial valves.

This is likely why cancer will always be with us and will be the hardest to combat:

Over the eons, cells have developed complex mechanisms that identify and correct many of the glitches. But the process is not perfect, nor can it ever be. Mutations are the engine of evolution. Without them we never would have evolved. The trade-off is that every so often a certain combination will give an individual cell too much power. It begins to evolve independently of the rest of the body. Like a new species thriving in an ecosystem, it grows into a cancerous tumor. For that there can be no easy fix.

And:

As people age their cells amass more potentially cancerous mutations. Given a long enough life, cancer will eventually kill you — unless you die first of something else. That would be true even in a world free from carcinogens and equipped with the most powerful medical technology.

That’s why, when it comes to cancer, the biggest bang for the buck is prevention, but, contrary to what is often claimed by quacks and cranks, it is not, nor will it ever be, possible to completely eliminate cancer through alterations in diet, lifestyle, or environment. It’s too much part of how our cells function, a consequence of evolution. In fact, I tend to look at cancer as evolution run amok in the body, but at the cellular level, rather than at the level of the organism. In fact, the organism suffers because of the cancer cell’s drive to reproduce and expand. it’s also the powerful force that makes cancer so hard to treat, because chemotherapy itself is a selective pressure selecting for ever more resistant cells. None of this is to say that large decreases in various cancers can’t be achieved through prevention. Eliminating tobacco use alone would cause enormous declines in one of the most lethal cancers, lung cancer. Obesity is also associated with certain cancers, and infectious agents, like H. pylori and HPV, are associated with others.

If I really wanted to get complicated, I could point out that not all cancers necessarily kill. For example, autopsy series demonstrate that 75% of men over 80 have identifiable foci of cancer in their prostates; yet nowhere near 75% of men who die over age 80 die of prostate cancer. The implication is obvious; the vast majority of prostate cancer is a disease that most elderly men die with, not of. Yet this very fact suggests that in at least one way Johnson is right. If men lived to be 150 or 200, rather than just 80, 90, or, occasionally, 100, there would be more time for those foci to continue to develop, and likely nearly every man would develop prostate cancer that actually threatens his life.

Life is indeed a sexually transmitted fatal disease. All science-based medicine can do is to try to prolong it as much as biology will allow, eliminate diseases that shorten it or cause suffering, and palliate diseases that can’t be cured.

99 Comments

Happy New Year Orac, and I hope you get better soon. Remember to take your organic, non-GMO greens, your oscillococcinum 30C and flu vax next time! We want you spouting insolence until you are 150 at least!

Here’s to the full recovery of the blinking box. I’m hoping to avoid that lung-hacking thing you have but this may be my year as I get it every couple of years and I believe I missed it last year.

I liken the SBM disease prevention/cure activity much as a game of whack a mole. Heart disease has been whacked a lot (slower mole?, bigger mole?, easier to see mole?) and cancer too but not quite so effectively. I blame vaccines, in part, for the cancer hyper-awareness and public disappointment. Vaccine preventable diseases were so effectively dealt with that we got spoiled into expecting that all disease would have such quick and decisive results.

This kind of article helps curb the unreasonable expectations but the history of 90+ % reductions in a disease sure look good.

MikeMa: Plenty of cross-cultural research has shown that a society’s perception of how healthy its members are is actually negatively correlated with objective measures of health. The leading explanation is that as a society becomes healthier, it redefines its expectations of what it means to be healthy, and the increase in expectations exceeds the progress.

In a society where there’s a good chance that your kids will predecease you, nobody is going to think of ordinary aches and pains and self-limiting illnesses as “ill health”. But when the big things have been dealt with, the little things start looming larger.

Houston mayor Annise Parker put it well. Asked about the recent tempest in a duck pond, she replied “I’ve been a gay community activist since the mid-70s, It was a very different time. We were fighting to keep people out of jails and mental hospitals. What some redneck wingnut has to say about the GLBT community is completely irrelevant.” Getting hot and bothered about Phil Robertson is a luxury we didn’t have back when we were dealing with basic survival issues.
The same goes for health and safety issues. Most Americans think violent crime is at an all-time high, even though it’s at one of its lowest levels historically, and their memories of “safe” times include the highest-crime period of their lifetimes. It would be a rare parent who didn’t believe that today’s kids are sicker than the kids of 75 years ago.

Guys, guys! What is echinacea, homeopathy, non-GMO greens, etc. going to do for a box of blinking lights? He needs to run McAfee or Norton, duh!

Strange to say that it’s a luxury that we get to complain about cancer. But as ebohlman points out, we redefine what is “sick” as we knock other stuff off the list. Many of the childhood killers are (mostly) a thing of the past, thanks in no small part to vaccinations. Eventually, we’ll get rid of today’s biggest killers, live well into our hundreds and have other diseases to worry about. Until then, if we want to beat death, all we need to do is find true love. After all, in the immortal words of that sage, Wesley, “Death cannot stop true love. All it can do is delay it a little while.”

It’s easy to forget how recently it was that children died before their parents. Four of my mother’s siblings died before reaching adulthood: two of medical conditions that are treatable today but weren’t in that time and place; one of injuries suffered in an automobile accident, which injuries would probably have been prevented with modern safety equipment; and one in a prairie fire (the last one would probably still have died even with 2014 medicine available), As more people survive these childhood conditions, of course more people die of chronic diseases associated with old age. Not that we don’t still see people dying of cardiovascular conditions (including a 20 year old in my town last month), but the people who do are more likely to have it as an undiagnosed latent condition (as was true of the aforementioned case); we’re getting better at screening older people who have traditionally been at risk.

her father, born in 1900, came from Ireland, telling many woeful tales- his beautiful, saintly mother died so young, his cousin, and best friend, was to attend Trinity but died suddenly before school started. He and his sister left their home country together.

Nearly 80 years later, her brother found out that he required a *pacemaker* then, their paternal aunt’s son had similar problems as did a 13 year old niece who was trying out for school sports. My cousin also was diagnosed with an arrhythmia that doesn’t require surgery. All told, several people needed medical interventions and dozens of close relatives were screened. No one has died suddenly- many of the older cousins are now in their 70s and early 80s.

I’m going to make that into a poster and hang it in my office. Ebohlman, succinctly and eloquently put. Our standards of health, education and welfare, at least where I am fortunate enough to live, are for the average citizen staggeringly luxurious when you compare it to even two generations ago.

My grandmother would probably have wept at the opportunity to attend school. Hell, my mother left school at 16 to go to work, married at barely 19 and began having the inevitable — at that time — annual baby.

Oh. I’m very sorry to hear that our most perspicacious- as well as perspicuous- host is down with the “crud”. The crud is nothing to joke about as one of my gentlemen is currently discovering- especially when it comes on top of asthma.

I will add, Orac, that that was a nice touch:
telling readers how you must go outside and battle snow on your own ( probably with a high-tech, baulky Japanese machine- we’re imagining how miserable that must be) when EVERYONE KNOWS that you are literally rolling in pharma dough and have a multitude of servants at your beck and call to do such menial, physical tasks.

Ah, this is my favorite argument from investigators with an axe to grind about modern science. It usually boils down to “I can’t get my work published so the publication system itself is EVIL and DESTROYING SCIENCE.”

Look, the current system has its issues, but this is a total caricature:

The perverse incentives created by the peer-review process ensure that the steadily increasing number of published articles in scientific journals often does not lead to new or original insights and, therefore, many new ideas do not show up in established journals. They can rather be found in books and working papers, where there is no pseudo-quality control which hinders innovative ideas. Although the peer-review process prevents the publication of obvious platitudes and nonsense on the one hand, on the other hand it promotes the publication of formally and verbally dressed-up nonsense.

There’s a play** by Eugene O’Neill that discusses health issues including addiction, alcoholism and tb. Supposedly based on the author’s family, the father’s frugality will probably result in his son’s death from tb – as he prefers a state hospital to a private clinic. A recurrent theme speaks about Irish relations who all died from tb ( they do live in a bog, after all) The mother is addicted to an opiate. There is no treatment for depression which appears to rule over most of them.

O’Neill was born in 1888 – thus the play probably represents the the teens. Tb was not unknown to his audience of 1941. One of my colleagues studied/ taught literature prior to becoming a psychologist- how was depression dealt with in 19th-early 20th century?- was his concern. He also studied Thomas Hardy.

Well, two coffee enemas and three days of intense juicing (using only the Mega-Juicer 350- that’s the only machine that preserves the Live Enzymes that will heal you) and you’ll be back to normal in no time.

One very striking thing when reading history is how people through most of history just randomly sicken and die in their 20s, 30s, 40s, and 50s.

There’s probably a very interesting study to be done, or already done, on how it affects attitudes to investment, risk, children, etc, when a 30yo can suddenly reasonably assume he’ll live to see his 60th birthday.

Jemima, are you seriously suggesting that immortality is possible, since you say only “pharma whores” would believe that life is 100% fatal? Do you carry a sword to fend off other Immortals, or are you afflicted with vampirism? What form of immortality are you proposing? I mean, not even Time Lords are truly immortal…..

There’s probably a very interesting study to be done, or already done, on how it affects attitudes to investment, risk, children, etc, when a 30yo can suddenly reasonably assume he’ll live to see his 60th birthday.

I’m told that the origin of 65 as a retirement age comes from the time of Frederick the Great of Prussia, who needed to be seen as doing something about old people. He and his brain trust supposedly knew something that most German workers at the time did not: in those days few German workers survived to the age of 65. That was quite a different world from today: two of my grandparents lived into their 90s, and my mother has several friends in that age range. Some of her friends are worried about outliving their retirement money. As with younger people, those who can afford to invest should be much more aggressive when the time horizon is 25 years or more than when it is five years or less.

Re 65 as retirement age, the version that I heard is that it originally applied to veterans from Bismarck’s armies, and the number was chosen to be low enough that a propagandistically useful number of old soldiers did qualify, but high enough not to burden state coffers very much. But I note that the WP page on Bismarck says his original Old Age Pension program of 1889 had retirement at 70.

Frederick’s time is surely too early. At that time the typical Prussian “worker” was an agricultural serf.

Most people with Alzheimer’s usually die from secondary conditions, often d/t progressive loss of motor skills. For example, as a patient with Alzheimer’s loses more motor skills, they begin to have difficulty swallowing food, leading to an increase in risk for choking or inhalation pneumonia. Also, loss of motor skills can lead to patients not moving around as much, which increases the risk of bedsores and infection, which in the case of the population affected by Alzheimer’s, can lead to an increased risk of death.

If anyone else with more medical education and background cares to chime in, please do so. This is what i know from the top of my head.

My best friend’s mother is currently dying of Alzheimer’s — she’s reached a stage where she can barely speak, rarely does anything spontaneously, and sleeps more and more of the time. (This is a great improvement over last year, when she suffered a lot from anxiety and was sometimes nearly frantic with confusion and fear.) Anyway, as I understand it (without being particularly well informed) even though the disease first attacks the parts of the brain for memory and cognition, other neurons are affected too, and motor skills start to go for example, and if as novalox says secondary complications don’t kill, eventually vital functions will just shut down.

The heading reminded me of a news report here the other day. It was talking about Vitamin D, and how studies suggest taking a supplement doesn’t, as some claim ‘ward off cancer, other diseases and even death’.

Can only assume the journalist thought death was something that could actually be avoided.

Some days can be difficult; that, I can attest. Last Saturday, I did a fall in a 6-steps stair and hurt my back pretty badly. I took a pair of tylenol that evening and was basically okay but Sunday, I was in serious pain so I had leftover demerol from my august surgery and I took them to control the pain. Needless to say, I’m now badly constipated and it’s hurting in the intestines (mostly for the gases).

You know, a little bit of money made the world go round last thursday as I took the taxi from the local bus terminus / microbrewery to home after a good diner at said microbrewery (with a latte). total time outside was about 1 minute top (from the bus to inside, inside to taxi and taxi to home) with 10 seconds standard deviation.

DW: double layers for everything, including head. I have a nice running hood (Christmas last year) and a turtle scarf, wore two layers of sweat pants and a t-shirt, sweater and down jacket-just to go to the gym and back. I bummed rides for both directions, and spent maybe four minutes outside today.
A lady in the next state over told me she bought her fiance a union suit- and I envied the lucky fellow.

Sheesh, the wind chill is only –35 F here, but I have to walk everyplace. (Weirdly, I keep getting compliments on my preposterous outfit of M-51 trenchcoat [3rd Army], size 13 yellow rubber farm boots, and full-length Baker scarf from unexpected quarters, such as 60-year-old Black ladies waiting for me outside the grocery store. And then I have to explain that the chevron isn’t really mine.)

Yesterday we had temperatures between 50 and 56 F. According to the weatherforecast we have nice weather in the Netherlands, because it’s cold in the US. So thanks for taking the cold. It saves a lot on heating for me.

Dear Mrs Woo, Blinking Box (or Our Glorious Leader*, if you will) & anyone else suffering through the polar vortex, whether sick or not – I wish you all the best & hope you can afford the “luxury” of not having to get out in the elements until the weather improves… 😉

The Oxford Dictionary of Quotations attributes “Life is a sexually transmitted disease” to “Graffiti found on the London Underground, in D. J. Enright (ed.) ‘Faber Book of Fevers and Frets’ (1989).” “Life is a sexually transmitted disease and the mortality rate is one hundred percent” is attributed to R.D. Laing in 1988. I haven’t actually found “Life is a fatal disease” in Paula Gunn Allen’s Koot Hoomi–esque channeling of Pocahontas, but it might not just be on the cover. I have a hard time believing that the coinage wasn’t in circulation well before any of these.

20 years ago I learned the secret of cashmere ( which isn’t as expensive as you think- there are discounters/ re-sale)- it makes a big difference for me. I have a deceivingly thin-looking black cardigan that serves me better than a fleece jacket-
( altho’ there are new technical innovations sold at shops that cater to skiers and climbers).

I also have a coat, lined leather gloves and a few scarves.

I am especially concerned for Narad – who has Raynaud’s IIRC. I have a tendency towards frozen fingers but not any real underlying condition.

Alain: We’re still dealing with a windchill advisory. Lucky for me, school was canceled for the second day in the city. (I help herd field trips.) So I get to enjoy the luxury of not being out in balmy 1 degree temperatures.

“Life is a sexually transmitted disease and the mortality rate is one hundred percent” is attributed to R.D. Laing in 1988.

Only if you’re an overly-zealous Bayesian statistician.

Assuming the (roughly-estimated) number of modern humans who have ever lived is 108 billion, then 7% of them are currently alive (i.e. not dead). We of course cannot simply assume that all these 7+ billion will die, at least not until they (we) are actually observed to kick the bucket. Some might not. Plus, others will be born in the course of our data collection and they, too, might not die.

In the words of Steven Wright: “I plan to live forever. So far, so good.”

Read presidential biographies to see how far we’ve come in health and medicine. The presidents and their families reflect what was happening in American society at the time. We’re not likely to have another president who had polio or a president who watched two of his sons die of (now) curable diseases. Even President George H.W. Bush lost a daughter to cancer which now may be curable.
My 97 year old client has pain from arthritis and other issues, and he probably has prostate cancer but he is not sick, thanks to his doctors and his daughter and us caregivers.

Kinda OT but kinda ties in to “good old days” discussion above: one of my woo-muddled relations, on her daily re-posting spree on The Facebook, posted an argument from antiquity (something like “why is it called alternative when chemical medicine was only invented 100 years ago”) back to back with with a post about how she can’t do word problems in math (the one ending in “purple because aliens don’t wear hats,” if anyone else has had the misfortune). I’M PROUD OF MY IGNORANCE OF THE PREREQS, SO LISTEN TO ME ABOUT SCIENCE! The *whirrRRR…kablooey…plink* sound at this end of the internet was my irony meter redlining and then giving up entirely.

I sometimes try to set people straight incrementally, such as by pointing out that one ounce of wheatgrass juice cannot possibly have all the benefits of six pounds of veggies because one of those benefits is being unable to fit a donut down my gullet afterward so what else are they exaggerating, but I cannot see where to begin in this case.

Do any Insoleers have advice about how to handle this situation, including a discount irony meter wholesaler?

@Alain #64: I’m sorry to have inadvertently commented-‘n-run, thereby giving the impression of ignoring you! [I’ve developed the bad habit of reading RI after arriving home in the evening, when I tend to be distracted by such things as phone calls & the need to make dinner…] I’m glad you feel better & are no longer completely frozen 🙂
@ebrillblaiddes: I wish I COULD help you with such instances, but my IronyMeter is currently out of order too – I have a (once very close) family friend who recently declared herself “cured” of Stage IV Cancer in her Christmas Newsletter.
Of course, it was her Naturopath & NOT her Oncologist & Surgeon who was responsible for this miracle, a miracle achieved “mainly through a strict adherence to a high Alkaline Diet”, if I understand correctly… So depressing, especially when you consider that this is a person with a considerable tertiary academic background.

@AntipodeanChic: was the alkaline diet the one with lemons in it, or the one where they’re supposed to drink baking soda water? Or are those the same? I can never get all those straight…nor have I managed to figure out how sugar is bad because it “feeds the cancer”, but juicing is good even though it makes your body absorb the sugar faster (or is that something to do with how sugar that comes in a bag is usually white and white food feeds white cancerfungi? [I feel icky for coming up with this even as a parody]).

Every time I let one go by unchallenged I feel guilty because silence is to some extent complicity, but I don’t know where to start. Is there a manual for this somewhere? If not, if we all pulled together in a wiki or something, could we write one?

Started the day here at -4 and ended at 33. They cancelled school to reduce the possibility of frostbite for the little ones. I used it as an excuse to postpone a brain MRI. Was happy to have outside temps increase quickly this morning.

@ebrillblaiddes: I *think* so, certainly there was a great supply of lemons in this persons house when I visited during the time of the “dreadful Allopathic Treatment” (chemo).
I wasn’t given too many details after I made a few “polite” inquiries as to how the “Alkaline Diet” was supposed to actually work at a cellular level – indeed, I was ultimately asked to leave after being accused of “trying to bring negativity into the house”. I wish I was kidding.

But yeah, Sugar I believe is referred to by these people as the White Death. As opposed to fungus.

I share your feelings of guilt & complicity. Maybe writing a wiki or similar is a good idea. I had half a mind to send this individual a link to: “http://www.skepdic.com/alkalinediet.html”
via email but ultimately decided against it. There’s no point.

I think I know the “polite” you mean. The one that involves translating what you want to say to what you actually say — for example, so that what you actually say is “I don’t see how that would work since lemons are acidic plus your blood has an elaborate buffering system” when what you mean is “if you could change fundamental things about your body that easily you would DIE AFTER EVERY MEAL, you biochemically illiterate numbskull!”

In the 18th century, Jean-Jacques Rousseau was advised by a court physician to drink more wine.
In pre-prozac time, ethanol could be an acceptable substitute, I guess.
Instead, he spent some time touring the south of France. We like to think the fresh air and sightseeing of sunny landscapes did him some good.

Sometimes the best you can do is to hold off the inevitable. My grandmother lived to age 98 following a double mastectomy, removal of a number of lymph nodes, undergoing some of the first radiation therapy in our area and, later, chemotherapy. Throughout all of that, she was active (very!) and a devoted gardener with numerous flowers, roses, shrubs, and a 1/4 acre vegetable garden, all the work on them done by herself.

A good life made longer by medical treatment…you can’t really ask more than that.

Apparently naked mole rats have never been observed to develop cancer for as long as they’ve been studied. I’m not sure how and when research on this species could translate into therapies for humans, but perhaps cancer isn’t inevitable for all mammalian life.

The mole rat thing is rather interesting, and means that there’s something that can effectively bar the formation of tumors even if we’re not sure why it works, or whether it could eventually be used for cancer prevention in humans.

In any case, even if we never “cure” cancer, just getting it to an AIDS-like situation where it’s suppressed indefinitely would be a major accomplishment.